Healthcare Provider Details

I. General information

NPI: 1073586509
Provider Name (Legal Business Name): FRANKIE DELGADO CANAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PINE RIDGE HOSPITAL EAST HIGHWAY 18
PINE RIDGE SD
57770
US

IV. Provider business mailing address

PO BOX 6004
PINE RIDGE SD
57770-6004
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-3006
  • Fax:
Mailing address:
  • Phone: 605-867-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10657
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: